Many different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). Twenty-six items were selected as suggested by current literature and for reasons of economy and practicability. The factor analyses resulted in a two-factorial solution with the behavioural items loading on one factor and the physiological parameters on the other (principal component analyses). The physiological parameters blood pressure, respiratory rate and heart rate were found to be unreliable and had no discriminant power to detect an analgesic demand during the postoperative period (discriminant analyses, ROC-curves). In newborns and infants, nine observational items were identified as equally selective, reliable, sensitive and specific to the assessment of postoperative analgesic demand, whereas in young children only five items could be identified (discriminant analyses, ROC-curves). For economic reasons, these five items (crying, facial expression, posture of the trunk, posture of the legs, motor restlessness) were chosen as the basis of an additional pain scale ranging from 0=no pain to 10=maximal (Children's and Infants' Postoperative Pain Scale, CHIPPS). Its internal consistency yielded values for Cronbachs' alpha with 0.92 for toddlers and 0.96 for infants. The coefficient for interrater reliability was 0.93. The scale was validated constructively by the intravenous administration of metamizol, tramadol, nalbuphine, piritramide and ketamine (repeated measures analysis of variance). The Toddler-Preschooler Postoperative Pain Scale and CHIPPS equally identified painfree situations or analgesic demand in 87.4%. In cases with definite pain, the score of CHIPPS was never below 4 points. Seventy-one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92-0.96 and 0.74-0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.

Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies.

Research on the assessment and management of pain in infants and children has increased dramatically, with the consequence that a wide variety of behavioral, physiological, and psychological methods are now available for measuring pediatric pain. Although the criteria for a pain measure for children are identical to those required for any measuring instrument, special problems exist in pediatric pain measurement because the influence of developmental factors, previous pain experience, and parental attitudes on children's perceptions and expressions of pain is not known. This article reviews the recent advances in the measurement of pain in children, with special emphasis on the methods that satisfy the criteria for reliability and validity, the methods that can be used to assess multiple dimensions of pain, and the methods that may be appropriate for assessing all types of acute, recurrent, and chronic pediatric pain.

An assessment of children's pain: a review of behavioral, physiological and direct scaling techniques.

This study explored children's self-assessment of the pain experience. Using a 10 cm scale with the ends marked 'I have no pain' and 'I have very severe pain,' school-age children rated the severity of their pain. The pain scale responses were related to physiologic parameters; body, facial, and vocal indicators of pain; and word descriptors of pain while controlling for the effects of medications given. Both the magnitude of chi-square values and the measures of association supported the validity of the pain scale as an indicator of the pain level of school-age children.

Assessing children's responses to pain

As part of a wider research project aimed at investigating how children think about several aspects of pain, definitions of pain used by 680 Irish schoolchildren aged 5–14 years were examined to see if a developmental pattern could be identified in the acquisition of a verbally mediated concept of pain. The results are consonant with a Piagetian developmental model, suggesting the possibility of delineating typical concepts of pain which correspond to successive stages of cognitive development.

Developmental aspects of children's definitions of pain

Content validity of an instrument to measure young children's perceptions of the intensity of their pain.

Children's perception of pain was investigated in an exploratory study. Some synaesthetic aspects were examined such as the color of pain, texture, shape, pattern and continuous vs intermittent qua...

"It hurts red:" a preliminary study of children's perception of pain.

Students' attitudes toward women and changes in those attitudes after taking a women's studies course were studied. The Spence Attitude Toward Women Scale was administered to 354 undergraduate stud...

Women's Studies as Change Agent*

Abstract Doucet C, Johnston L, Hiscock A, Bermarija T, Hammond M, Holmes B, Smith T, Lalonde B, Parent D, Deacoff C, Scott R, Kurek J, Jamieson R. 2023. Synoptic snapshots: monitoring lake water quality over 4 decades in an urbanizing region. Lake Reserv Manage. 39: 101–119.   Synoptic water quality surveys—measuring major ions, nutrients, pH, organic matter, and trace elements—have been conducted in ∼50 lakes in the Halifax Regional Municipality (Nova Scotia, Canada) once per decade since 1980. In this study, lake water quality over 40 yr was examined and urban development was evaluated as a possible driver of observed changes. More than half of the lakes experienced strong (>50%) increases in conductivity, iron, sodium, chloride, calcium, and total phosphorus (TP), and strong decreases in acidity (i.e., [H+]). Between 20% and 50% of the lakes experienced strong increases in nitrate, alkalinity, zinc, color, aluminum, dissolved organic carbon, and magnesium, and strong decreases in manganese and sulfate. In 2021, national guidelines for the protection of aquatic life were exceeded by chloride, aluminum, manganese, and arsenic in certain lakes. Land cover classification from circa 1980 and 2020 revealed that although change in urban development within the lake watersheds ranged from a decrease of 11 percentage points to an increase of 48 percentage points, the majority (90%) of watersheds experienced an increase. Urban development was associated with increased chloride, conductivity, sodium, calcium, and TP concentrations. Other parameters appear to be more influenced by hydrology, watershed characteristics, climate, and decreased acid deposition. Results highlight emerging water quality concerns, such as elevated aluminum concentrations, and increased concentrations of chloride, nutrients, and arsenic, which should be the focus of strategic monitoring and mitigation efforts.

Synoptic snapshots: monitoring lake water quality over 4 decades in an urbanizing region

Characterizing spatial heterogeneity is fundamental in numerous areas, yet defining spatial patterns often depends on qualitative assessments or a priori knowledge. Lacunarity analysis is a popular occupancy‐based method for identifying relevant length scales in spatially heterogeneous systems. From lacunarity, we identify the existence of a point which encapsulates the spatial heterogeneity of a given system. This value satisfies the conditions for the lacunarity cutoff function and forms the basis of a heterogeneity index. We evaluate the behavior of both parameters in monofractal, clustered, and periodic systems. In addition, we demonstrate the broad utility of our approach to the scientific community by classifying the spatial heterogeneity of fractured sea ice and comparing our findings to existing measures. The heterogeneity index produced a linear correlation with the area fraction of open ocean to ice with an R2 of 0.967.

A Lacunarity‐Based Index for Spatial Heterogeneity

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"It hurts red:" a preliminary study of children's perception of pain.

Women's Studies as Change Agent*

Synoptic snapshots: monitoring lake water quality over 4 decades in an urbanizing region

A Lacunarity‐Based Index for Spatial Heterogeneity